Iron Deficiency Anemia
Tenly is a 6-year-old child with excessive sleep. Her teacher reports that she been sleeping excessively at daytime, drinks a lot of water, and appears pale. The child has been accompanied by the grandmother because the parents work long hour day shifts. She eats well without issues and the grandmother reports that she has a good appetite. She attends after-hours care in the evening. Other questions that might be essential to ask Tenly and her grandmother are what comprise the child’s diet from breakfast to dinner and any abnormal cravings. Another question would be whether the child has been dewormed in the recent past (Maaks et al., 2019).
Investigations for Tenly will include; a complete blood count to check the hemoglobin level and red cell indices which may not be altered if it is mild. However, a low hemoglobin, hematocrit, red cell count is expected. The MCV, MCH, and MCHC are also reduced while RDW is increased. A peripheral smear will show microcytic and hypochromic anemia. Iron studies will reveal low serum iron, transferrin, and ferritin levels while total iron-binding capacity will be increased. Her most likely diagnosis is iron deficiency anemia. Differentials will include; hookworm infestation and vitamin B12 deficiency (Maaks et al., 2019).
According to Goddard et al., (2011), her treatment will involve supplementation of iron. This is to replenish stores while treating the underlying cause. Oral elemental iron of 3-5mg is recommended for about 3 months. Dietary education should also be done. Meals should include meat, pork, liver, green leafy vegetables, cereals, and nuts. The child might face barriers to education because of hospitalization if it is severe and needs a blood transfusion. She might also face difficulties in concentration in class. Challenges to her care might appear in drug dispensation because the child moves from grandmother to school and after-hours care without spending quality time with parents. It is expected that the symptoms will resolve after about a month or two after the iron stores have been replenished. Therefore, the child will be active in school and at home (Lopez et al., 2016).
References
Goddard, A. F., James, M. W., McIntyre, A. S., & Scott, B. B. (2011). Guidelines for the management of iron deficiency anaemia. Gut, 60(10), 1309-1316.
Lopez, A., Cacoub, P., Macdougall, I. C., & Peyrin-Biroulet, L. (2016). Iron deficiency anaemia. The Lancet, 387(10021), 907-916.
Maaks, D. L. G., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., & Duderstadt, K. (2019). Burns’ Pediatric Primary Care E-Book. Elsevier Health Sciences.